Provider Demographics
NPI:1376830844
Name:SHURTLEFF, LISA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SHURTLEFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 NORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1397
Practice Address - Country:US
Practice Address - Phone:706-348-8674
Practice Address - Fax:706-348-8676
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional